Reflective practice in physiotherapy curricula: a survey of UK university based professional practice coordinators

Physical therapy student perception of self-reflection activities in a musculoskeletal course: A mixed-method study

BACKGROUND

Deliberate reflection is an effective method to aid in professional development. Most documented self-reflection activities (SRA) occur during clinical experiences. Literature on SRA within the didactic component of entry-level physical therapy education is lacking.

PURPOSE

The purpose of this mixed-method study was to evaluate student perception of in-class SRA.

METHODS

A convenience sample of 61 students in a DPT program was recruited. Students were enrolled in a musculoskeletal course and participated in six 10-minute SRA. At the end of the course, students completed a survey to assess perception.

RESULTS

Fifty-nine (97%) students completed the anonymous survey. Most reported they would continue SRA in future courses (92%, 55/60) and as a professional (95%, 57/60). Thematic analysis identified SRA promote the professional qualities of self-evaluation, confidence, and clinical excellence. Quiet time, self-evaluation, and sharing with others were identified as benefits of SRA. Curricular threading of SRA in entry-level physical therapy education was strongly suggested.

CONCLUSION

Self-reflection activities can be implemented into the didactic portion of entry-level physical therapy education and be perceived positively by students. Future research can assess the impact of SRA on clinical reasoning development during the didactic portion of entry-level physical therapy education.

Does team reflexivity impact teamwork and communication in interprofessional hospital-based healthcare teams? A systematic review and narrative synthesis

Background

Teamwork and communication are recognised as key contributors to safe and high-quality patient care. Interventions targeting process and relational aspects of care may therefore provide patient safety solutions that reflect the complex nature of healthcare. Team reflexivity is one such approach with the potential to support improvements in communication and teamwork, where reflexivity is defined as the ability to pay critical attention to individual and team practices with reference to social and contextual information.

Objective

To systematically review articles that describe the use of team reflexivity in interprofessional hospital-based healthcare teams.

Methods

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six electronic databases were searched to identify literature investigating the use of team reflexivity in interprofessional hospital-based healthcare teams.

The review includes articles investigating the use of team reflexivity to improve teamwork and communication in any naturally occurring hospital-based healthcare teams. Articles’ eligibility was validated by two second reviewers (5%).

Results

Fifteen empirical articles were included in the review. Simulation training and video-reflexive ethnography (VRE) were the most commonly used forms of team reflexivity. Included articles focused on the use of reflexive interventions to improve teamwork and communication within interprofessional healthcare teams. Communication during interprofessional teamworking was the most prominent focus of improvement methods. The nature of this review only allows assessment of team reflexivity as an activity embedded within specific methods. Poorly defined methodological information relating to reflexivity in the reviewed studies made it difficult to draw conclusive evidence about the impact of reflexivity alone.

Conclusion

The reviewed literature suggests that VRE is well placed to provide more locally appropriate solutions to contributory patient safety factors, ranging from individual and social learning to improvements in practices and systems.

Trial registration number

CRD42017055602.

Reflective Practice in Physical Therapy: A Scoping Review

BACKGROUND

Many practitioners experience complex, uncertain, and unique clinical practice situations that can be navigated with reflection. Little is known about the theoretical and pragmatic perspectives of reflection in physical therapy.

PURPOSE

The purpose of this paper was to examine the literature on reflection in physical therapy and identify gaps in the literature.

DATA SOURCE

The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, EMBASE, Scopus, and PsycINFO were used to identify articles.

STUDY SELECTION

Studies were selected to describe: (1) theoretical concepts related to reflection, (2) examples of reflection, and (3) the use of reflection in clinical or educational contexts.

DATA EXTRACTION

Authors, year of publication, country of origin, publication type or source, methodology, conceptual approach (including terminology used, definition of terminology used), and practical approach (including theoretical underpinning, context of reflection/reflective practice, and target group) guided the data extraction.

DATA SYNTHESIS

A total of 46 articles were reviewed spanning from 1992 to 2017, which included research studies, field articles, editorials, and a review article. Theoretical underpinnings of reflection were based on the thoughts of Donald Schön. Written approaches to reflection were most common, and reflection was used to inform education, clinical practice, and professional growth.

LIMITATIONS

As with any review paper, there is a certain level of interpretation required when collating and interpreting data.

CONCLUSIONS

Reflection in physical therapy could be advanced by a thorough conceptualization of reflective practice, a broader and deeper pool of research to inform optimal implementation of reflection across the career span from learners to experts, and a clear definition and linkage of reflection to epistemologies of physical therapy practice.

Learning to See Beneath the Surface: A Qualitative Analysis of Family Medicine Residents' Reflections About Communication

Patients share straightforward statements with physicians such as describing their fears about their diagnosis. Physicians need to also understanding implicit, indirect, subtle communication cues that give broader context to patients' illness experiences. This project examines physicians' written reflections that offer insight into their interpretation of both the stated and the tacit aspects of their observations about communication, their resulting responses, and their intended actions. Tufts University Family Medicine residents (N = 33) of the Tufts Family Medicine Cambridge Health Alliance completed three reflective exercises each week over the course of 1 year (756 reflective entries). An interdisciplinary research team identified communication-related concepts within the reflections. Identified themes include (a) physicians recognizing and discovering mutual interplay of their communication with and patient disclosure, (b) physicians paying attention to subtleties of patient behavior as indicative of a fuller picture of patients' lives and their coping with illness, and (c) physician images of growth and awareness about communication indicative of their potential for growth and improvement. The project extends the literature in communication and medical education by examining explicit and tacit points of reflection about communication. The project (a) allows for unpacking the multifaceted aspects of reflection and (b) bridges reflective theory and medical education with communication foundations.

Radiation therapists’ perspectives of the role of reflection in clinical practice

A recurring theme from the literature is that the definition of reflection is nebulous and/or complex. Many authors have suggested that more research needs to be conducted to better understand an individual’s perception of reflection and reflective practice, and how these concepts affect their clinical practice as well as their personal growth and development. This paper offers the findings of a qualitative study of radiation therapists in Canada. The aim of the study was to explore radiation therapist’s understanding of the concept of reflection, and to understand how they incorporated it into their daily practice. Secondary objectives were to examine some of the perceived barriers to its use, and the possible challenges of implementing reflective writing. Two focus groups were initially conducted, and a follow-up questionnaire was developed using the themes generated from the focus groups. The questionnaire was distributed to radiation therapists at two large cancer centres in Toronto, Canada. Most participants indicated that it is an integral part of their practice and professional lives, and that they use a variety of different methods for engaging in reflection. It is not without its barriers, but many of these can be overcome by providing time, coaching and a supportive work environment. Respondents were divided as to whether they would benefit from being taught reflection; however, small group teaching would be the favoured method. Further study is suggested to determine whether there are any improvements to patient care and in particular patient outcomes.

Calibrating urgency: triage decision-making in a pediatric emergency department

Triage, the first step in the assessment of emergency department patients, occurs in a highly dynamic environment that functions under constraints of time, physical space, and patient needs that may exceed available resources. Through triage, patients are placed into one of a limited number of categories using a subset of diagnostic information. To facilitate this task and standardize the triage decision process, triage guidelines have been implemented. However, these protocols are interpreted differently by highly experienced (expert) nurses and less experienced (novice) nurses. This study investigates the process of triage; the factors that influence triage decision-making, and how the guidelines are used in the process. Using observations and semi-structured interviews of triage nurses, data was collected in the pediatric emergency department of a large Canadian teaching hospital. Results show that in emergency situations (1) triage decisions were often non-analytic and based on intuition, particularly with increasing expertise, and (2) guidelines were used differently by nurses during the triage process. These results suggest that explicit guideline information becomes internalized and implicitly used in emergency triage practice as nurses gain experience. Implications of these results for nursing education and training, and guideline development for emergency care are discussed.

Focus group study of student physiotherapists' perceptions of reflection

CONTEXT

The reflective practice module in the physiotherapy programme at the University of Limerick, Ireland represents the first incidence of the inclusion of such a module within physiotherapy curricula in Ireland. However, research examining the contribution of reflection as a means of learning is limited, particularly from the student perspective.

OBJECTIVES

This study sought to explore students' perceptions of reflection and its potential contribution to their development before and after the module.

METHODS

A qualitative research methodology using focus groups was employed to evaluate physiotherapy undergraduate students' perceptions of the module. Three focus groups were held in total. Two were held with Year 3 students, before and after their reflective practice module, respectively, to examine any changes in their perceptions of reflection. A third was held with Year 4 students to determine their perceptions after both the module and subsequent clinical placements. Sessions were audiotaped, transcribed and subjected to in-depth thematic analysis to resolve the significant themes that emerged from the data.

RESULTS

Students reported a more advanced level of reflective ability post-module completion. They perceived personal and professional benefits to practising reflection and recognised these skills as strategies with which they could continue to facilitate their professional development. For students, time constraints in the clinical setting represented a barrier to reflection.

CONCLUSIONS

Students support inclusion of the module in their training, acknowledging its role in improving their confidence and clinical reasoning, and facilitating continuing professional development. Further studies are required to generalise these findings to a wider population.

The feasibility of an electronic reflective practice exercise among physiotherapy students

BACKGROUND

Reflective practice is a skill that serves as a model for continuous learning. Like any skill, reflective practice can be improved and health professional curricula should include opportunities to develop these skills. The clinical component of health professional curriculum is a natural component where reflective practice skills can be developed. Electronic means will help students and faculty stay in contact during clinical internships.

AIMS

The purpose of this study was to evaluate the feasibility of an electronic reflective practice exercise during a clinical internship and explore the potential trends on students' reflective practice skills and self-directed learning readiness.

METHODS

We used a prospective pre-post intervention design in a cohort of physiotherapy students to examine feasibility and explore trends. Faculty also rated the depth of reflection papers. In addition, students completed a reflective practice exercise questionnaire and the self-directed learning readiness scale (SDLRS) was completed pre- and post-internship.

RESULTS

All 84 students completed the reflective practice questionnaire. Sixty-six students consented to complete the questionnaire and 17 consented to complete the SDLRS pre- and post-internship. It took an average of 7 min for faculty to review each student's reflection and there were no significant electronic difficulties encountered. Initial reflection papers were rated at a descriptive (23%), descriptive-analytical (28%) or analytical level (33%). Eighty-six percent of students rated faculty feedback as helpful and 92% rated peer feedback as helpful. Almost all students (97%) students reported that they followed through on some or all of the items on their reflective practice learning plans. The SDLRS significantly improved with the exercise (mean difference 6.8 +/- 9.9; p < 0.05).

CONCLUSIONS

This electronic reflective practice exercise during the physiotherapy students' clinical internship was feasible and demonstrated trends to positively impact the learners' skills and self-directed learning readiness.